Radical neck dissection: Elective, therapeutic, and secondary.

The effectiveness of elective en bloc, therapeutic en bloc, and secondary radical neck dissections is evaluated in patients whose primary tumor remained controlled following initial treatment (surgery, irradiation, or combined therapy). Pathologically documented cervical involvement following elective en bloc, therapeutic en bloc, and secondary radical neck dissections occurred in 80 (27%) of 295, 158 (67%) of 237, and 77 (75%) of 102 of the patients, respectively. Patient survival is greater if cervical metastases are surgically removed while occult, rather than if they are resected after they are clinically suspected. Patients who have a 15% to 20% or greater likelihood of having occult cervical metastases will have an increased probability for survival if the surgical management includes an elective en bloc radical neck disection.